HomeMy WebLinkAbout2014 RESULTSMONITORING SYSTEM CERTIFICATION
For Use By All Jurisdictions Within the State of Cal(fornia
Awhority Cited: Chapter 6. 7, Health and Safety Code: Chapter 16, Division 3, Title 23, Califomia Code of Regulations
This form must be used to document testing and servicing of monitoring equipment. A separate certification or report must be prepared for each
monitoring system control panel by the technician who performs the work. A copy of this form must be provided to the tank system
owner/operator. The owner/operator must submit a copy of this form to the local agency regulating UST systems within 30 days of test date.
A. General Information
Facility Name: Mesa Marin Chevron Bldg. No.: ____ _
Site Address: 11101 Highway 178 City: Bakersfield __ Zip: ..:..9..:....33;;....;0;....;6 __ _
Facility Contact Person: Mohammud Muthana Contact Phone No.: (661) 366-4886
Make/Model ofMonitoring System: Veeder-Root TLS-350 Date of Testing/Servicing: 1/9/2014
B. Inventory of Equipment Tested/Certified
-"'-'-n. llU..._ .:11111•'-'J.It fUll'-IIIV.A~ llV fUUI ... Hl.'-_,lll!o.-... tfl"-'-UfJ,If11'-'1t'l Uf~JI'-"-'l'-UJ'.;J\.t •t'-·'-U•
Tank ro: 10000 gal. Regular Tank 10: 10000 gal. Plus
18! In-Tank Gauging Probe. Model: 847390-107 18] In-Tank Gauging Prohc. Model: 847390-107
0 Annular Space or Vault Sensor. Model: 0 Annular Space or Vault Sensor. Model:
0 Piping Sump Tn:nch Scnsor(s). Model: 0 Piping Sump I Trench Sl.·n.-.or(s). Model:
0 Fill Sump Sl.'t1Mlr(s). Model: 0 Fill Sump Scnsor(s). Model:
0 Mechanical I inc I cak Detector. Model: 0 M<.:chanical Line l...c;1k Detector. Model:
18] Electronic Line l.eak Detector. Model: PLLD 1:81 Electronic Line Leak Detl.'Ctor. Model: PLLD
18] Tank Overfillllligh-Level Sensor. Model: 847390-107 1:81 Tank Overfill/ High-1 cvcl Sensor. Model: 847390-107
0 Other (specify equipment type and model in Section I on Page 2). 0 Other (specifY equipment type and model in Secti()fl Eon Page 2)
Tank 10: Tank 10:
0 In-Tank Gauging Probe. Model: 0 In-I ank Gauging Probe. Model:
0 Annular Space or Vault Sensor. Model: 0 Annular Space or Vault Sensor. Model:
0 Piping Sump I I rcnch Sensor(s). Model: 0 Piping Sump I Trench ScrMr(s). Model:
0 Fill Sump S~..·n:;or(s). Model: 0 Fill Sump Sensor(s). Model·
0 Mechanical I inc Leak Detector \olodcl: 0 \olechanieal Line Leak Detector. Model:
0 Flectronic I inc I cak Detector. Model: 0 Electronic Line Leak Oetcctor. Model:
0 Tank Ovcrfillllligh-Lcvel Sensor. Model: 0 Tank Overfill Ill igh-Lcvel Sensor. Model:
0 Other (specifY <:quipmenttype and model in Section I' on Page 2). 0 Other (specify equipment type and model in Section Eon Page 2).
Dispenser 10: 1&2 Dispenser 10: 3 & 4
0 Dispenser Containment Sensor(s). Model: 0 Di;,pl.'ll.'><.'r Containment Sen;;or(s). Model:
18] Shear Valve(;,). 18! Shear Valvc(s).
18! Dispenser Containment Float(s) and Chain(s). 18! Dispenser Containment Float(s) and Chain(s).
Dispenser 10: Dispenser 10:
0 Dispensl.T Containment Sensor(s) Model: 0 Oi;,pl.'ll.'>CI' Containment Scnsor(s). Model:
0 Shear Valvc(s) 0 Shear Valvc(s).
0 Dispenser Containment Float(s) and Chain(s). 0 Dispenser Containment Float(s) and Chain(s).
Dispenser 10: Dispenser 10:
0 Dispenser C'ontainm<:nt Sensor(s). Model: 0 DispcrlSCI' Containment St•nsor(s). Model'
0 Shear Valvc(s) 0 Shear Valvc(s).
0 Dispenser Contamment Float(s) and Chain(s). 0 Dispcr1ser Containment Float(s) and Chain(s).
•If the facility contains more tanks or dispensers, copy this form. Include information for every tank and dispenser at the facillly.
C. Certification -I certify that the equipment identified in this document was inspected/serviced in accordance with the
manufacturers' guidelines. Attached to this Certification is information (e.g. manufacturers' checklists) necessary to verify that this
information is correct and a Plot Plan showing the layout of monitoring equipment. For any equipment capable of generating such
reports, I have also attached a copy of the report; (check all that apply): ~ System set-up ~ Alarm history report
Technician Name ~~~~--
Certification No.: B34106 License. No.: 804904 ~~~~------------------------
Kristo~her Karns Signature:
Testing Company Name: Confidence UST Services, Inc. Phone No.: (800) 339-9930
Site Address: 1101 Highway 178, Bakersfield, CA 93306 Date ofTesting/Servicing: 1/9/2014
Page 1 of 3
Monitoring System Certification
D. Results of Testing/Servicing
Software Version Installed:_..:.1..:.4·:..:0~0 _____________ _
c fl ,..~ ..... "' ~··~~····~··
~Yes 0 No* Is the audible alarm operational?
~Yes 0 No* Is the visual alarm operational?
~Yes 0 No* Were all sensors visually inspected, functionally tested, and confirmed operational?
~Yes 0 No* Were all sensors installed at lowest point of secondary containment and positioned so that other equipment
will not interfere with their proper operation?
0 Yes 0 No* If alarms are relayed to a remote monitoring station. is all communications equipment (e.g., modem)
183 N/A operational?
183 Yes 0 No* For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment
0 N/A monitoring system detects a leak, fails to operate, or is electrically disconnected? I fyes: which sensors initiate
positive shut-down? (Check a// that apply) 0 Sump/Trench Sensors; 0 Dispenser Containment Sensors.
Did you confirm positive shut-down due to leaks and sensor failure/disconnection'? 0 Yes; 0 No.
183 Yes 0 No* For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e., no
0 N/A mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank
fill point(s) and operating properly? If so, at what percent of tank capacity does the alarm trigger? 90%
0 Yes* !81 No Was any monitoring equipment replaced? If yes, identifY specific sensors, probes. or other equipment
replaced and list the manufacturer name and model for all replacement parts in Section E, below.
~Yes* 0 No Was liquid found inside any secondary containment systems designed as dry systems? (Check a// that apply)
0 Product; 183 Water. If yes, describe causes in Section E, below.
181 Yes 0 No* Was monitoring system set-up reviewed to ensure proper settings? Attach set up reports, if applicable
183 Yes 0 No* Is all monitoring equipment operational per manufacturer's specifications?
* In Section E below, describe how and when these deficiencies were or will be corrected.
E. Comments: Positive shutdown is only for Fail Safe & ESO as system does not have liquid sensors.
0.2 & 0.1 tank tests are not consistently passing on 0.2 monthly or 0.1 annually. A SEM Key with CSLD
will need to be installed and activated.
Page 2 of 3
Monitoring System Certification
F. In-Tank Gauging I SIR Equipment: 181 Check this box if tank gauging is used only for inventory control.
0 Check this box if no tank gauging or SIR equipment is installed.
This section must be completed if in-tank gauging equipment is used to perfonn leak detection monitoring.
Complete the following checklist:
181 Yes 0 No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults?
1:8:1 Yes 0 No* Were all tank gauging probes visually inspected for damage and residue buildup?
1:8:1 Yes 0 No* Was accuracy of system product level readings tested?
1:8:1 Yes 0 No* Was accuracy of system water level readings tested?
1:8:1 Yes 0 No* Were all probes reinstalled properly?
1:8:1 Yes 0 No* Were all items on the equipment manufacturer's maintenance checklist completed?
* In the Section H, below, describe how and when these deficiencies were or will be corrected.
G. Line Leak Detectors (LLD): 0 Check this box ifLLDs arc not installed.
c -he foil ~ ------------kr --·----
1:8:1 Yes 0 No* For equipment start-up or annual equipment certification. was a leak simulated to verifY LLD performance?
0 N/A (Check all that apply) Simulated leak rate: 1:8:1 3 g.p.h.; 0 0.1 g.p.h ; 0 0.2 g.p.h.
1:8:1 Yes 0 No* Were all LLDs confirmed operational and accurate within regulatory requirements?
1:8:1 Yes 0 No* Was the testing apparatus properly calibrated?
0 Yes 0 No* for mechanical LLDs, does the LLD restrict product flow if it detects a leak?
1:8:1 N/A
1:8:1 Yes 0 No* For electronic LLDs, does the turbine automatically shut offifthe LLD detects a leak?
0 N/A
1:8:1 Yes 0 No* For electronic LLOs, does the turbine automatically shut off if any portion of the monitoring system is disabled
0 N/A or disconnected?
181 Yes 0 No* For electronic LLDs, does the turbine automatically shut ofT if any portion of the monitoring system
0 N/A malfunctions or fails a test?
1:8:1 Yes 0 No* For electronic LLOs, have all accessible wiring connections been visually inspected?
0 N/A
1:8:1 Yes 0 No* Were all items on the equipment manufacturer's maintenance checklist completed?
* In the Section II, below, describe how and when these deficiencies were or will be corrected.
H. Comments:
Page 3 of 3
i
MESA MARIII PIT STOP MARKET 11101 HWV 178 BA~ERSFIELD.CA 9330b
JAtl g. 2014 9:0~ Al1
SYSTEI1 STATUS REPORT
Q 3:ANtiUAL LIIIE FAIL
0 3:PERIODIC LitlE FAIL
I tNEIITORY REPORT
T I : Utii.EADED VOLtJ1E • 6208 CAI.S ULLAGE • 3777 CA!.S
90:: ULLAGE• 2778 GALS TC VOLUME D 6174 GALS
HEIGHT • 56.55 I~HES
WATER VOL • 0 CAI.S WATER • 0.00 JflCHES
TEMP • b7.7 DEC F
T 2:DIESEL VOLLt1E • :l493 CAI.S
ULLAGE • 6502 GAI.S
90:; ULLAGE• 5503 GAI.S TC VOLUME • 3464 GALS
HEIGHT " 36,07 ltiCHES WATER VOL • u CA!.S WATER • 0.00 filCHES
TEMP • 71.5 DEG F
T 3:SUPER UULEADEO
V0Llt1E • 3421 r-1\I.S
ULLAGE • 6564 '-oi.S 90:: ULLAGE• 5565 GAI.S
TC VOLtJ1E ~ 3395 GA!.S HEIGHT • 35.58 HICHES
WATER VOL • 0 GALS ~ oTER " 0. 00 JIICHES TEMP • 70.3 DEG F
T 4!PLlS VOLtJ1E • 3:.,~4 CAI.S
ULl.ACE • 6751 CAI.S
90'/o ULLAGE• 5752 GAI.S TC VOLUME • 3206 GALS
HEIGHT • 34. 14 IIICHES W~TfR VOl. • • · lJ GALS WATER • 0.00 IIICHES
TEMP • 72.2 DEG F
~ ~ M ~ ~ E"D ~ ~ A ~ ~
SOFTWARE REVISIOU LEVEL
VERSION 14.00 SOFTWAREd 346014·100-A
CREATED -97.02.10.13.33
S-HODULE" 330160-010-A SYSTEM FEATURES:
PERIODIC Jti·TAII~ TESTS ANIIUAL I II-TAM: TESTS
PRECISIOII PLLD
SYSTEM SETUP
JAil 9. 2014 9:04 AM
SYSTEM UNITS u.s. S\'STEM LPIIGUO.CE
S::IICLISH :..tSTEH DATE/TIME P:>Rt1AT
NON DO \"IYY HH:tfl:SS >H
MESA NA?.IN PIT STOI' HAR~ET 11101 HWY 178 EAKE~FIELO.CA 93306
SHIFT TINE I : 4:30 AN
SHIFf TINE 2 : DISABLED
SHIFT TINE 3 : DISABLED
SHIFT TIME 4 : DISABLED
PERIODIC TEST WARIIItiGS
DISABLED
AtltiUAL TES". WARtlltiCS
DISABLED
PRitiT TC VOLtJ1ES
EIIABLED
TEHP COMPEtiSAT I Otl
VALUE CDEG F):. 60,0
H-PROTOCOL DATA FORMAT
HEIGHT
RE-DIRECT LOCAL PRIIlTOUT DISABLED
SYSTEM SECURITY CODE : 000000
COtt1UIHCATIOIS SETUP
PORT SETTINGS:
COifl BOARD I <RS-232)
BAUD RATE 9600 PARITY EVEN
STOP BIT I STOP
DATA LEIICTH 7 DATA
AUTO TRAtiSI11T SETTifl~:
AUTO LEAK ALARH LIMIT
DISABLED AIJfO HIGH t..W-\TER LIMIT
DISABLED
AUTO OVERFILL LIMIT
DISABLED
AUTO LOW PROD~-r
DISABLED
AUTO THEFT LIMIT
DISADLED AUTO DELIVERY START
DISABLED
AUTO DELIVERY EtlD
DISABLED A liTO E>ITERNAL I NPIIT ON
DISABLED AUTO EXTERNAL I tiPUT OFF
DISABLED AUTO SEtlSOR FUEL ALARM
DISABLED
AUTO SENSOR WATER AlARM DISABLED
AUTO SEtiSOR OUT ALARM
DISABLED
RS-232 SECURITY
CODE : 000000
RS-232 EtlO OF MESSAGE DISABLED
lti-TAtll: SETUP ------. -----
T I :UIILEADED PRODUCT COVE THERMAL COEFF TAN~ DIAMETER TAll~ PROFILE FULL VOL
I ,000700 95.00
I PT 10003
FLOAT SIZE: 4.0 ttl. 8496
WATER WARNWG : 2.0 HIGH tJATER LIMIT: 3.0
MAX OR LADEL VOL: OVERFILL LIMIT
HIGH PROOI)."T
DEI.IVERY Lll11T
LOW PROOU\,"'T
LEAK AU\RM LIMIT: SUDDEN LOSS LIMIT: TANK TILT :
11AIU FOLDED TAlll:S Til! NOllE
LEA~ MIU I'ERIODIC:
LEAl: Hill AllllUAL :
9985 so:: 9002 95V. 9502 15}:
1500
500
99 99 (),30
15$: 1500
15': 1500
PERIODIC TEST TYPE STAtiDM.~D
AllfiUAL TEST FAIL ALARI1 DISABI.ED
PERIODIC TEST FAIL ALARM DISABLED
GP.OSS TEST FAIL ALARM EtlABLED
Atlll 'Jl:.l:>"T AVERAGitl\:: OFF PER :EST AVERAGitiG: OFF
TAIIK TEST t~TIFV: Otl
Ttl~ TST SIPHOII BREAK:OFF
DELIVER'/ DELAY : I MIN
T 2:DIESEL PRODI.CI' CODE THERt1AL COEFF TANK DIAMETER TAll~ PROFILE FULL VOL
.,
.000470 95.00 1 PT 10003
FLOAT SIZE: 4,0 !fl. 6496
WATER lJARNI tiG • HICII WATER LIMIT:
MAX OR LABEL VOL: OVERFILL LIMIT :
HICH f'RODUCT
DELIVER\' LIMIT
LOW PRODUCT LEAl: AI..ARH l.IHJT: SUDDEN LOSS LIMIT: TAIII~ TILT :
11Ail!FOLDED TAlll\5 Til: !lOll£
2.0 3.0
9965 ~():( 9002 95::
9502 6:: 600
500 99
99 0.20
LEAK Mltl PERIODIC: IS:' : 1500
LEAK Ml II AtltlUAI. : I~ 1500
PERIODIC TEST TYPE STANDARD
AllllliAL TEST FAIL AU\RM Dlei!BLED
PERIODIC TEST FAIL AU\RM DISABLED
GROSS TEST FAIL ALARM EllABLED
Atlll TEST AVERACI tlG: OFF
PER TEST AVERACttlG: OFF
TAN._ TEST l~T IF\': ON
Ttl!: TST SIPHON BREAl::OFF
DELIVERY DEl.AY : I MIN
T 3:SUPER UtlLEADED PRODUCT CODE : 3 THERMAL COEFF : .000701l TAll~ DIAMETER : 95,00
TAUK PROFILE : I PT FULL VOL : 10003
FLOAT SIZE: 4.0 ttl. 8496
WATER WAR!UtlG HIGH WATER LIMIT:
MAY. OR 1.1\BEL VOL: OVERFILL LIMIT
HICH PRODUCT
DELIVERY LIMIT
LOW PMDUCT LEAK AU\Rt1 LIMIT:
SUDDEN LOSS LIMIT:
TAtiK TILT :
MAIHFOLOED TAIIY.S Til! llOtlE
2.0 3.0
9985 90:: 9002 95:: 9502
10~· 1000
500
99 99 1.04
LEAK MIN PERIODIC: IS!; : 1500
LEAl: Hltl AWIUAL : 15:: 1500
PERIODIC TEST TYPE STAUDARD
AIHIUAL TEST FAIL ALA'RI"' DISABLED
PERIODIC TEST FAIL Al.ARM DISABLED
CROSS TEST FAIL ALARM EIIABLED
Atltl TEST ~VERACIII.:;: OFF PER TEST 1\VERAG ltlG: OFF
TAtu: TEST t~TIFV: ON
Ttl~ TST SIPHOtl BREAl:!OFF
DELl VERY DELAY : I Ill tl
T 4:PLUS PRODL);..I CODE
THERt1AL COEFF
TAU){ £11AI"'ETER TAll){ PROFILE FULL VOL
4 .000700 95.00
I PT 10003
FLOAT SIZE: <1.0 Ill. 8496
WATER WARIHtiG : 2.0
HIGH WATER LIMIT: 3.0
1-\1\X OR LABEL VOL:
OVERFILL LIMIT ;
IIJGH PRODUCT
DELIVER'/ l.JHIT
LOW PRODUo.,"T : LEA){ ALARM LIMIT: SUDDEtl LOSS LIMIT: TAtn: TILT :
MANIFOLDED TANI:S Til: NOllE
LEA~ Hltl PERIOD!~:
LEAl! Hill AWIUAL ;
9985 90Y. 9002 9~: 9502
JOY. 1000
1000 99 99
0.74
15~:
1500
ISY. 1500
PERIODIC TEST T\'PE STAIIDARD
AWIUAL TEST FAIL ALARM DISABLED
PERIODIC TEST FAIL
ALARM DISABLED
GROSS TEST FAIL ALARM ENABLED
Allll TEST AVERAGIIIG: OFF PER TEST AVERACitiG: OFF
TArn: TEST NOTIFY: Otl
Till: TST SIPHOtl BREAI::OFF
DELIVERY DELAY : I MIN
LE11K TEST METHOD ------------TEST MONTHLY : ALL TAN~ WEE}: I MOll START TIME : 12!30 AH
TEST RATE :0.20 GAL/HR DURATION : 2 HOURS
LE11~ TEST REPORT FOR114T
IIORAAL
PRESSURE LitlE LEA~: SETUP ------------
0 I : UULEADED
PIPE TYPE: STEEL
LitlE LEIIGTH: 225 FEI:.i 0.20 GPH TEST: EtiABLED 0.10 GPH TEST! DISABLED
SHUTDOWII RATE! 3.0 GPH
T I :Uti LEADED DISPEIISE MODE:
STAilDARD SEIISOR: tiOti-VEtiTED
0 2:DIESEL
PIPE TVPE: STEEL
LINE LENGTH: 155 FEET
0.20 GPH TEST: EUAELED 0.10 GPH TEST: DISABLED SHUTDOWII RATE: 3.0 GPH
T 2:DIESEL
DISPENSE MODE: STAtiDARD
SEtSOR: fiOti-VENTED
0 3:SUPEP. UNLEADED
PIPE T\'PE: STEEL LlfiE LENGTH: 225 FEET
0.20 GPH TEST: EtiABLED
0.10 GPH TEST: DISABLED SHUTDOWt~ RATE: 3.0 GPH
T 3:SUPER UNLEADED
OJSPEtiSE MODE: STAIIDARD SENSOR: tiOII-VEtiTED
Q 4:PLUS
PIPE T\'PE: STEEL
LitlE LENGTH: 50 FEET
0.20 GPH TEST: ENABLED
0.10 GPH TEST: DISABLED SHUTDOWN RATE: 3.0 GPH T 4:PLUS
DISPENSE NODE:
STANDARD
SENSOR: tiOtl-VEtiTED
OUTPUT RELAY SETUP ------------
R t:OVERFilL ALARM
T\'PE:
STANDARD NORHALL'/ OPEN
I N-TAtH: ALARMS ALL:OVERflLL ALARM
ALL!HIGH FRODUCT ALARM
PLLD LINE DISABLE SETUP ------------
0 I :UNLEADED -NO ALARM ASSIGt.t1EIITS -
Q 2:DIESEL
-UO ALARM ASSIGtlMEtiTS -
Q 3!SUPER UNlEADED
-NO ALARM ASSIGtlMEtiTS -
Q 4:PLUS
-tiO ALARM ASSICt.t1EtiTS -
ALARM HISTOR\' REPORT
-----SENSOR ALARI'l ----0 1:UIILEADED
AtiiiUAL LINE FAIL
JAH 5. 2014 3:11 Al1
ANU~L LIUE FAIL DEC 29. 2013 12:09 ~1
Allti~L LINE FAIL DEC 22. 2013 t:52 AH
ALARM HISTORY REPORT
-----SEfiSOR ALARM -----Q 2:DIESEI.
HICH PRESSURE WARN
AUG 28. 2013 11:57 AH
HIGH PRESSURE 1111\Rfl AUG 28. 2013 11:31 AH
ALAPJ1 HISTORY REPORT
-----SEtiSOR ALARM -----0 3:SUPER UNLEADED
PERIODIC LINE FAIL DEC 31. 2013 11:36 ~M
AtlfiUAL LlllE FAIL DEC 31. 2013 8:11 ~
AIIU~L LitlE FAIL
DEC 28. 2013 11:27 ~M
ALARM HISTORY REPOP.T
-----SEfiSOR ALARM
Q 4:PLUS
TAll~ LEA~ TEST HISTOR\'
T I :UflLEADED
LAST CROSS TEST PASSED: JAil 6. 2014 12:30 AH START! fiG VOLUME• 3447
PERCEfiT VOLU1E • 34.5 TEST TYPE • STAtlDARD
LAST AfHIUAL TEST PASSED:
110 TEST PASSED
FULLEST AtltiUAL TS"i PASS
tlO TEST PASSED
LAST PERIODIC TEST PASS:
DEC 2. 2013 12:30 N1 TEST LENGTH 2 HOURS STARTltlC VOLUME• 5557
PERCEtiT VOLUME • 55.6
TEST TYPE • STAIIDARD
FULLEST PERIODIC TEST
PASSED EACH MONTH:
SEP 2. 2013 12:30 AH
TEST LENGTH 2 HOURS STARTING VOLUME• 7740 PERCEtiT VOLUME • 77.4
TEST TYPE • STANDARD
OCT 7. 2013 12:30 AM TEST LEfiGTH 2 HOURS
STARTltK> VOLIJ1E• 6005 PERCEtiT VOLU1E • 60.0
TEST TYPE • STAIIDARD
DEC 2. 2013 12:30 AH
TEST LEtiGTH 2 HOURS
STARTING VOLUME• 5557 PERCEtiT VOLUME • 55.6 TEST TYPE • STAfiOARD
TAll~ LEAl: TEST HISTOR'/
T 2:DIESEL
LAST CROSS TEST PASSED: JAN 6. 2014 12:30 AM
START! fiG VOLUME" 2298
PERCEtiT VOLUME • 23.0
TEST TYPE " STANDARD
LAST AtlfiUAL TEST PASSED:
NO TEST PASSED
FULLEST AWIUAL TEST PASS
tK> TEST PASSED
LAST PERIODIC TEST PASS:
tiOV 4. 2013 12:30 AH
TEST LENGTH 2 HOUP.S START!~ VOLUHE• 3949 PERCEtiT VOLUME • 39.5
TEST T'IPE • STANDARD
FULLEST PERIODIC TEST
PASSED EACH HOtiTH:
SEP 2. 2013 12:30 AH
TEST LEtrn'H 2 HOURS STARTltiG VOLLt1E• 3694 PERCEtiT VOLtR1E • 36 • 9
TEST TYPE • STAfiDARD
NOV 4• 2013 12:30 AH TEST LEtiGTH 2 HOURS STARTING VOLUHE~ 3949
PERCE tiT VOLUME • 39.5 TEST TYPE " STAIIOARD
TAW\ LEAl: TEST HISTORY
T 3!SUPER UNLEADED
~GROSS TEST PASSED:
JAtl 6. 2014 12!30 AH
STARTING VOLUMEo 2897
PERCENT VOLlJ1E • 29.0 TEST 'll'PE • STAIIDARD
LAST ANtllii'IL TEST PASSED:
NO TEST PASSED
FULLEST AlltiUAL TEST PASS
NO 'fEST Pf\SSED
LAST PERIODIC TEST PASS: JAtl 6. 2014 12:30 AM
TEST l.ENGTH 2 HOURS START I 1-K> VOLU1E• 2897 PERCEtiT VOLUME .. 29,0
TEST 'riPE .. STAriOARD
FULLesT PERIODIC TEST PASSE[) EACH MOtiTH!
JAil 6. 2014 12!30 AM TEST LEilGTH 2 HOURS
START I tK> VOLUME• 2897
PERCENT VOLUME • 29.0
TEST 'll'PE .. STANDARD
SEP 2. 2013 12!30 AH
TEST LEtlGTH 2 HOURS
STARTitiG VOLUME• 3609 PERCEIIT VOLI.t1E ., 36.1
TEST 'll'PE • STAIIDARD
NOV 4. 2013 12!30 AH
TEST LEtlGTH 2 HOURS STARTING VOLUME• 3442
PERCEIIT VOLU'IE • 34.4
TEST 'll'PE • STAtiMRD
DEC 2. 2013 12:30 AM TEST LEilGTH 2 HOURS STARTING VOLUME• 3106
PERCEtiT VOLli1E • 31 • I
TEST 'll'PE • STANDARD
TAU~ too: !f>ir HISTORY
T 4:PLUS
LAST CROSS TEST PASSED: JAil 6. 2014 12!30 AM STARTit~ VOLI.t1E• 3451 PERCEriT VOLUME • 34.5 TEST 'll'PE • STAtlDARD
LAST AlltlUAL TEST PASSED!
110 TEST PASSED
FULLEST ANIIUAL TEST PASS
tlO TEST PASSED
~ PERIODIC TEST PASS: JAtl 6. 2014 12!30 AM
TEST LEIICTH 2 HOURS
STARTING VOLUME• 3451
PERCENT VOLUME • 34.5 TEST n'PE • STAIIDARD
FULLEST PERIODIC TEST PASSED EACH MOIITH:
JAtl 6. 2014 12:30 AM TEST LEtiGTH 2 HOURS
STARTitiG VOLUtiE• 3451
PERCEtiT VOLUME a 34.5
TEST 'll'PE a STAtlDARD
SEP· 2. 2013 12!30· ill1 --TEST LEtlGTH 2 HOURS START!t~ VOLI.t1Ev 3535
PERCEtiT VOLUME • 35.3
TEST 'll'PE • STAIIDARD
OCT 7. 2013 12!30 AM
TEST LENGTH 2 HOURS STARTING VOLUME• 3100 PERCENT VOLUME a 31.0
TEST 'll'PE .. STAtiDARD
DEC 2. 2013 12!30 AM
TEST LENGTH 2 HOURS
START!rl\0 VOLUME• 2967 PERCE IIT VOLlJ1E • 29. 7 TEST 'll'PE a STANDARD
MESA HARIN
PIT STOP HARI:ET I I 101 HW'/ 178 BAJ;ERSFIEI.D.CA 93306
JAN 9. 2014 9:07 AU
LEAK TEST REPORT
T I :UtiLEADED PW>BE SERIAL tiiR1 199016
TEST STARTIIIG TIME: JAU 6. 2014 12:30 AH
TEST LENGTH • 2.0 HRS STRT VOLUME • 3447.9 CAL
START TEHP • 69.8 F
EIID TEMP .. 69.9 F
TEST PERIODS 2-4
-0.00 0.01 0.02
LEAK TEST RESULTS
RATE ,. 0.01 GAL'HR 0,10 CAL-·HR TEST JtM.
0.10 CAL/HR FLAGS:
LOW LEVEL TE:>""T ERROR LEA~ TEST TOO SHORT
HESA HARIII PIT STOP HARI:ET 11101 I-LlY 178 BA~ERSFIELD.CA 93306
JAN 9. 2014 9:07 AH
LEA~ TEST REPORT
T 2:DtESEL
PROBE SERIAL tlllt 605932
TEST STARTING TIME: JAN 6, 2014 12!30 AM
TEST LEtiGTH • 2.0 HRS STRT VOLIJ1E ., 2298 , 2 GAL
START TEHP • 72.. I F
EfiD TENP • 72. I F
TEST PERIODS 2-4 o.oo 0.00 0.00
LEA~ TEST RESULTS
RATE • 0,00 CAL/I!R 0.10 CAl-'HR TEST ltNL
0.10 GAL/HR FLAGS: LOW LEVEL TEST ERP.OR
LEAl\ TEST TOO SIIORT
MESA HARW Pl1' STOP 11ARI{ET
11101 1-«J\' 179 BAI{ERSFIELD.CA 93306
JAil 9, 2014 9:07 At1
lEAl\ TEST REPORT
T 3:SUPER UNLEADED PROBE SERIAL tlllM 157356
TEST STAP.THIG TINE: JAtl i), 2014 12!30 AH
TEST l.EtiGTH • 2.0 HRS STRT VOLU1E • 2997.0 CAL
START TEHP • 71 .I F EIID 'TEHF' • 71 .I F
TEST PERIODS 2-4 0.00 0.02 0.02
LEAl: TEST RESULTS RATE .. 0.01 GAL/HR 0. I 0 CAJ.....'HR TEST ltiVL
0.10 CAL/HR FLAGS: LEAl: TEST TOO SHORT
MESA HARIII PIT STOP HARI{ET 11101 HWY 179 BAI\ERSFJELD.CA 93306
JAil 9. 2014 9:oa AM
LEAl: Te."T REPORT
T 4!f'LUS PROBE SERIAL tllJ1 63-1210
TEST STARTif~ TII1E: JAil 6. 2014 12!30 At1
TEST LENGTH • 2. 0 IIRS STP.T VOLUNE " 3451 .I CAl.
START TEHP • 72. I F EtiD TEMP .. 72.1 F
TEST YERIODS 2-4
-0.00 -0.00 -0.01
lEAl: TEST RESULTS
RATE • -0.00 GAL'IIP.
0.10 CAL/HR T~""T IIIVL
0.10 GAL/IIR FLAGS:
lEAl: TE.'>T TOO SHO?.T
HESAtiARIIl
PIT STOP HARI:ET
Ill 01 HW'I 178
BAI\ERSFIELD.CA 93306
JAN 9. 2014 9:09 AH
PRESSURE !.HIE LEAl\ TEST
HISTORY
Q I :UNLEADED
LAST 3. 0 CAIAIR PASS:
JAN 9. 2014 8!52 AM
FIRST 0.20 CAL/IIR PASS
EACH MONTH:
JAN 1. 2CJI4 9:15 PH DEC 1. 2013 10!38 Pt1 tiOV 1. 2013 12!36 Al1 OCT 1. 2013 4:45 PH
SEP 2. 2013 3:38 AH
AUG 29. 2013 11!43 PH
FIRST 0.10 GAL/HR PASS
EACH NOIITH:
JAil 9. 2014 8 29 AH
DEC 1. 2013 12 23 AM
NOV 1. 2013 12 52 AM OCT 1. 2013 10 50 PH
SEP 2. 2013 4 10 AM
MESA HARJU PIT STOP HARY.ET
11101 KJV 178 BAY.ERSFIEI.D.CA 93306
JAil 9. 2014 9:09 AH
PRE5"SURE LIIIE LEAl: TEST
HISTOR'I
Q 2:DIESEI.
LAST 3.0 CAL/HR PASS:
JAN 9. 2014 8:29 AM
FIRST 0,20 GAJ.....'IfR PASS
EACH MONTH:
JAil 1. 2014 6:15 AM
DEC 1, 2013 I :31 Pt1 NOV 1. 2013 10:13 AM OCT 1. 2013 8:10AM
SEP 1. 2013 7:16PM AUG 28. 2013 1:~7 PM
FIRST 0,10 GAL/HR PASS
EACH MOilTH:
JAN 9. 2014 8:29 AM DEC 2. 2013 12:58 AM t~V 1. 2013 10:44 AH OCT 1. 2013 11!41 PH
SEP 1. 2013 7:47PM
MESA IIARIII PIT STOP HARI:E1' 11101 ~ 178 BAKERSFIELD.CA 93306
JAN 9. 2014 9:09 AM
PRESSURE LltlF. LEAl: TEST HISTORY
0 3!SUPER UIILEADED
LAST 3.0 CAL/HR PASS:
JAil 9. 2014 8:29 At1
FIRST 0.:?0 GAL/HR PASS EACH 1101/TH!
DEC I. 2013 6:28 PH NOV 1. 2013 4!42 PM
OCT 1. 2013 9:33 1'\1'1 SEP 1. 2013 7:47PM AUG 28· 2013 I: 13 PH FIRST 0.10 GAL/HR PASS EACII NOIITH:
DEC 2. 2013 12!•15 At1 IIOV 1.2013 5!13PM OCT 1. 2013 9!49 AM
SEP 1. 2013 9!21 PH
AIX: 28. 2013 I :45 Pl'1
MESA MAR!Il
PIT STOP t1ARI:ET 11101 HWY 178 BAl:ERSFIELD.CA 93306
JAfl 9. 2014 9:09 At1
PRESSUP.E Ll tiE LEf\1: TEST
HISTORY
0 <!:PLUS
LAST 3.0 CAL/H?. P~:
JAfl 9. 2014 7:22 1\H
FIRST 0.211 GliLIIIR PASS
EACH MONTII:
JAil 1. 2UI4 t:oiOPM DEC 1. 2013 3:25 PH NOV 1. 2013 10:01 AM
OCT 1. 2013 111!29 AM SEP 1. 2013 1:24PM AUG 28. 2013 12:21 PH FIRST 0.10 GAL/liP. PASS
EACH HOIITH:
JAfl 1. 2014 1!55 PM DEC 1. 2013 5:43PM IIOV 1. 2013 10:16 At1 ocr 1. 2013 3:52 ~~ SEP I. 2013 10:43 PM
PRESSURE L !fiE LEAY. ALARM
Q 2:DIESEL GROSS LitlE FAIL
JAtl 9. 2014 10:39 IV1
PRESSURE L ltlE LEAK 1-\LARM 0 2:DIESEI. PLLD SHUTOOWU AlARt1 IArl. 9. 2014 10:39 AH
PRESSURE LitlE LEAK SETUP --.----------
Q I :UNLEADED
PIPE TYPE: STEEL LINE LENGTH: 225 FEET 0,20 GPH TEST: ENABLED
0.10 GPH TEST: ENABLED
SHUTDOWtl RATE: 3.0 CPH T I :UNLEADED DISPErSE NODE:
STAIIDARO
SEflSOR: fiOfi-VEtiTED
Q 2:DIESEI.
PIPE TYPE: STEEL LitlE LEflGTH: 155 FEET 0.20 GPH TEST: ENI'IBLEO
0. I 0 GPH TEST: EtlABLEO SHUTDOWtl RATE: 3. 0 GPII
T 2:DIESEL
DISPENSE NODE:
STANDARD SEIISOR: tlOfi-VEIITED
Q 3:SUPER UfiLEADED
PIPE TYPE: STEEL
LitlE LEtlGTH: 225 FEET
0.20 GP/1 TEST: EUABLED
0.10 GPH TEST: EtiABLED SHUTDOWil RATE: 3.0 GPH
T 3:SUPER UNLEADED DISPEtiSE NODE: STANDARD
SElSOR: NON-VEtiTEO
Q 4:PLUS
PIPE TYPE: STEEL
LINE LEIIGTH: 50 FEET 0.20 GPH TEST: EtlABLED
0, I 0 GPH TEST: EflABLED
SHUTDOWtl RATE: 3.0 GPH
T 4:PLUS
DISPENSE NODE:
STAUDAP.D
SEIISOP.: tiON-VEtiTED
PRESSURE LINE LEAK AlfiRH
Q 3:SUPER UtlLEADED GROSS LitlE FAIL
JAN 9. 2014 10:48 AH
PRESSURE LINE LEA!: ALARI'I 0 3:SUPER UULEADED
PLLD SHUTDOWN AlARM
.iAtl 9. 2014 10:48 AM
PRESSURE LitlE LEA!: ALAI<t1
Q 4:PLUS
GROSS LINE FAIL JAil 9. 2014 10:52 Pl1
PRESSURE LitlE LEAK ALARM
Q 4:PLUS PLLO SHUTDOWII ALARM JAN 9. 2014 10:52 AM
PRESSURE Ll tiE LEAl: ALARM
Q I :UNLEADED
GROSS LINE FAIL JAN 9. 2014 II :01 AM
PRESSURE LlfiE LEAl\ ALARH
0 I :UNLEADED
PLLD SHUTDOWN ALARM JAN 9. 2014 11:01 AH
MESA MARIN PIT STOP MARKET Ill 01 t«JY 178
BAKERSFIELO.CA 93306
JAil 9. 2014 11:12 AH
SYSTEM STATUS REPORT
Q I :GROSS LitlE FAIL
Q I :PLLD SHUl'DOWtl ALARM
Q 2:GROSS LINE FAIL
Q 2 :PLLO SHUTDOWfl ALARM
G 3:GROSS LitlE FAIL
0 3:AIHHJAL LitlE FA1L
0 3:PLLD SHUTDOWN Al.ARH
0 3:PERIODIC LitlE FAIL
Q 4:GROSS LitlE FAIL
Q 4 :PLLD SHUTDOWII ALARM
MESA MARIN
PIT STOP MARKET 11101 H.N 178 BAI:ERSFIELO.CA 9:l":.o.;
JAil 9. 2014 tt:l2 ~1
SYST.El1 STATUS REPORT ------------Q I :GROSS !.!liE FAIL
Q I :PLLD SHUTDOWII ALARM
Q 2:GROSS LitlE FAIL
Q 2:PLLD SHUTDOWN ALARM
Q 3:GROSS !.filE FAIL
Q 3!ANNUA!. LitlE FAIL
0 3!PLLD SHUTDOWII ALARH
Q 3:PERIODIC LitlE FAIL
0 4!GROSS LIIIE FAIL
Q 4 :PLLD SHUTDOWII ALARM
----I ti-TAtll: Al.AJlH -----T 4 :PLI.S
PROBE OUT JAfl 9. 2014 11:15 PH
----Jti-TANI{ ALARH -----T 3:SUPER UIILEADED
PROBE OUT JAil 9. 2014 11:16 PH
----W-TAN~: tJ\f.11 -----T 2!DIESE.L
PROBE OUT JAN 9. 201·1 II !I'/ lil1
----W-TAW: ALARN -----
T I :Uti LEADED
SUDDEII LOSS ALARM JAN 9. 2014 11:18 AM
----lti-TAW: ALARH -----T I :UNLEADED PROBE OUT JAN 9. 2014 11:18 AM
----111-TAIU{ ALARH -----
T I :UULEADED HIGH PRODUv"T ALARH
JAN 9. 2014 11!19 ~
NE!?:A MAR Ill PIT STOP NARI:ET
11101 IU( 178 BA~ERSFIELD.CA 93306
JAil 9. 2014 II !19 PH
SYSTEM STATUS REPORT ------------T I :SUDDEN LOSS ALAR1'1
T I :HIGH PRODUI,"T ALARH
Q 3!AIIIIUAL LitlE FAIL
Q 3:PERIODIC LitlE FAIL
lt~EtiTORY REPORT
T I : UIILEADED VOLU1E • 9786 GALS
ULLAGE • 199 GALS 90!: ULLAGE• 0 GALS TC VOLUME • 9738 GALS
HEIGHT • 89.74 INCHES ~TER VOL • 13 GALS ~TER " 0-80 INCHES TEMP a 65.9 DEG F
T 2:01ESEL VOLU1E • 7946 GALS
ULLAGE • 2039 GAl$
90Y. ULLAGE• I 040 GALS TC VOLUME • 7909 GALS
HEIGHT • 70.39 lt/CHES WATER VOL • 0 GAL$ l.lt\TER a 0.00 lt/CHES TEMP " 69.9 DEC F
T 3:SUPER UIILEADED
VOLlR1E • 7128 GALS ULLAGE • 2857 GALS
90': ULLAGE" 1859 CAts TC VOLU1E • 7088 GALS HEIGHT • 63.68 ltiCIIES
WATER VOL • 23 GALS l.lt\TER • 1 • I 8 ltiCHES TEMP • 66.0 DEC F
T 4!PLUS
VOLUME • 7213 GALS ULLAGE a 2772 GALS
90:: ULLAGE• 1773 GALS
TC VOLUNE • 7176 GALS HEIGHT • 64.36 WCH~ WATER VOL c 0 GALS
WATER • 0.00 ltiCHES TEMP • 67.3 DEC F
~ K W K K EIID ~ K K * ~
---
I tl-TAtlK ALARI1 -----
T 1 :UNLEADED
PROBE OUT JAil 9. 201<1 II :20 AH
----IN-TAtll\ ALARH -----T 2:DIESEL HIGH PRODUCT ALARM JAtl 9. 2014 11:22 AH
---Ill-TAt~ ALARH -----T 2:DIESEL
PROBE OUT JAN 9. 2014 11:22 AH
----IU-TAtiK ALARM -----T 3:SUPER UtiLEADEO
OVERFILL ALARM JAN 9. 2014 11!25 N1
----Jti-TAtlK ALARM -----T 3:SUPER Ulli.EADEO
PROBE OUT JAN 9, 2014 11:26 ~
----I N-TAtll{ ALARH -----
T 4:PLUS
OVERFILL ALARM JAN 9. 2014 11!28 AH
T 3!SUPER UIILEADED ltNENTORY ltiCREASE
I f~REASE START JAN 9. 2014 II :24 AH
VOLlt1E • 7128 GALS WATER • I • 17 lllCHES TEMP • 63.5 DEC F
ltlCREA.':lE END JAN 9. 2014 11!29 AH
V0Llt1E
WATER TEMP
• 913<1 GALS
• I .29 INCHES • 63.1 DEG F
CROSS lllCREASE• 2006 TC fiET WCREASE• 2004
----I N-TAfll: ALARN -----T 4!PL<1S PROilE OUT JAil 9. 2014 II !29 AN
T 4!£-I.US
I tNEttTORY I ti\:RE:f\SE
ltiCP.EASE START
JAU 9. 2014 II :27 At1
VOLl.tiE a 7213 GALS ~lATER • 0.00 !fiCHES TEMP • 61.5 DEC F
It/CREASE EfiD JAN 9. 2014 11!30 1'11
V0Llt1E • 9180 GALS WATER • 0.00 ltlCHES
TEMP " 61.3 DEG F
GROSS I f~REASEa I 967
TC fiET I tlCREASEa 1967
SOFTWARE REVISION LEVEL VERSION 14.00 SOFTWARE~ 346014-JOO·A
CREATED -97.02.10.13.33
S~DULEP 330160-0IO·A
SYSTEM FEATURES:
PERIODIC W-TAfiK TESTS AIIIIUAL IN-TANJ: TESTS
PRECISION PLLD
PRESSURE LitlE LEAK SETUP
Q I :UULEADED
PIPE 1YPE: STEEL
LitlE LEfiGTH: 225 FEET 0.20 GPH TEST: EtiABLED
0. I 0 GPII TEST: EtiABLED SHUTOOIJN RATE: 3.0 CPH
T I : UIILEADED DISPEtiSE NODE: STAUDARD SENSOR: tiON-VEttTED
Q 2!DIESEI.
PIPE T'/PE: STEEL LitlE LEIIGTH: 155 FEET
0,20 GPH TEST! EtiABLED 0.10 GPH TEST! EtiABLEO SHUTDOWJI RATE! 3.0 GP/1
T 2!0IESEI. DISPEIISE NODE: STANDARD SEt/SOP.: tiOti-VEttTED
Q 3!SUPER UIILEADEO
PIPE T'/PE: STEEL LitlE LENCTII: 225 FEET 0. 20 GPH TEST: EfiABLED 0. I 0 GPH TEST: EIIABLED SHUTDOWII P.ATE: 3.0 GPH T 3:SUPER UtiLEADED DISPErSE NODE! STAIIDARD SEIISOR: fiOti-VENTED
Q 4!PLUS
PIPE 1YPE: STEEL LitlE LENGTH: 50 FEET
0.20 GPH TEST: EtiABLEO 0.10 GPH TEST: ENABLED
SHUTOOWII RATE! 3.0 GP/1
T 4!PLUS DISPEtiSE MODE: STANDARD SEIISOR: tiOII-VENTED
t1ESA MARiti PIT STOP HARI:ET 11101 HU'/ 178 BAJ:ERSFIELD.CA 9330c>
JAN 9. 2014 11!36 ~1
S'ISTEI1 STATUS P.EFORT
Q 3:AtltiUAL LitlE FAIL
Q 3:PERIODIC LitlE FAIL
ltNEIITORV REPORT
T I : UIILEADED VOLl.tiE • 6190 GALS ULLAGE • 3795 GALS 90:; ULLAGE" 2796 GALS TC VOLUME " 6156 GALS HEIGHT • 56.42 INCHES
WATER VOL " 0 CALS
WATER • 0.00 IIICHES TEMP • 67.7 DEG F
T 2:DIESEL VOLUHE • 3.:a9:l GALS
ULLAGE = 6502 GALS 90~: ULLAGE• 5503 GHI.S
TC VOLUME • 3464 GALS
HEIGHT • 36.07 INCHES WATER VOL • 0 GALS
WATER " 0.00 INCHES
TEMP _ _ l-..7.! d. u'f.g. F ,.
T J!SUPER U/ILEADEU
VOLUHE • 3-143 GALS ULI L\-:>f • 6542 GALS 90% ULLAGE• 5543 GALS
TC VOLl.tiE • 3419 GALS
HEIGHT " 35.75 INCHES
WATER VOL • 0 GALS WATER " 0.00 IIICHES TS1P • 70.1 DEG F
T -t:PLUS VOLUME • 3232 GALS
ULLAGE = 6753 GALS 90% ULLAGE• 5754 GALS
TC VOLlt1E • 3207 GALS HEIGhT " 34.12 ltiCHES WATER VOL " 0 GALS
WATER " 0.00 IUCIIES
TEMP • 71 .0 DEG F
* ~ * * ~ END w W w ~ ~
SOFTWARE REVISIOI{ LEVEL VERS!Ot~ 14.00 SOFTWARE~ 346014-100-A CREATED-97.02.10.13.33
S-HODULE~ 330160-010-A
SYSTEM FEATURES: PERIODIC lfi-TAtll~ TESTS AIWLVIL I II-TANK TESTS PRECISIOU PLLD
SWRCB, January 2006
Spill Bucket Testing Report Form
This form is intended for use by contractors pe1jorming annual testing of UST spill containment stmctures. The completedfonn and
printouts from tests (ij applicable), should be provided to the facility ownerloperator.for submit/a/ to the local regulafOI)' agency.
1. FACILITY INFORMATION
Facility Name: Mesa Marin Chevron I Date of Testing: 01/09/2014
Facility Address: Ill 0 I Highway 178. Bakersfield. CA 93306
Facility Contact: Mohammud Muthana I Phone: 661-366-4886
Date Local Agency Was Notified of Testing: 01/02/14
Name of Local Agency Inspector (!{present during testing): Ernie Medina
2. TESTING CONTRACTOR INFORMATION
Company Name: Confidence UST Services. Inc.
Technician Conducting Test: Kristophcr Karns
Credentials': X CSLB Contractor X ICC Service Tech. 0 SWRCB Tank Tester rl Other (Specify)
License Number(s): CSLB #804904 ICC# 5264406-UT IT# 09-1743
3. SPILL BUCKET TESTING INFORMATION
Test Method Used: x Hydrostatic Vacuum [l Other
Test Equipment Used: Lake Test Equipment Resolution: .0625"
Identify Spill Bucket (By Tank I Regular 2 Plus 3 Super 4 Diesel
Number, Stored Product, etc.)
Bucket Installation Type: x Direct Bury x Direct Bury x Direct Bury X Direct Bury
0 Contained in Sump · Contained in Sump I I Contained in Sump 0 Contained in Sump
Bucket Diameter: 12.00" 12.00" 12.00" 12.00"
Bucket Depth: 15.00" 14.75 .. 14.00" 14.00"
Wait time between applying 5 min. 5 min. 5 min. 5 min. vacuum/water and start of test:
Test Start Time (T1): 9:30am 9:30am 9:30am 9:30am
Initial Reading (R1): 14.00" 14.25" 13.50" 13.25''
Test End 1 ime (TF): 10:30 am 10:30 am 10:30 am 10:30 am
Final Reading (RF): 14.00" 14.25" 13.50" 13.25"
Test Duration {T F-T1): 1 hour I hour I hour 1 hour
Change in Reading (RF-R1): 0.00" 0.00" 0.00" 0.75"
Pass/Fail Threshold or .0625" .0625" .0625" .0625" Criteria:
Test Result: X Pass OFaiJ X Pass 0 Fail X Pass 0 Fail X Pass OFail ------
Comments-(include information on repairs made prior to testing, and recommended.follow-up.for[ailed tests)
CERTIFICATION OF TECHNICIAN RESPONSIDLE FOR CONDUCTING THIS TESTING
I hereby certifY that all the information contained in this report is true, accurate, and in full compliance with legal requirements.
Technician's Signature: ~. -Kc.~ Date: 01/09/2014
1 State laws and regulations do not currently require testing to be performed by a qualified contractor. llowever, local requirements
may be more stringent.
Name:
Street:
City:
Terms:
~fiDE"+. oo CI(C\
\UST¥ • +' ,.lluc'f\o
~fiDE-+.
oo ~
~UST(J. ~ ~ c-,CES•
"BUilD WITH CONFIDENCE" "CCMPI.IANCE WITH CONAOENCE"
Lic.970703 Lic.804904
Toll Free#: 1-800-339-9930
Confidence UST
16250 Meacham Road
Bakersfield CA 933 14
rnDNmevvf.r I" rbrJFt~7iotJ
Job Order /Invoice #:
Site Name: ~AA-.£<1! ... ~£-IU /' J..J..r, '"'&tV
Street: t 11 o\ ~u L ~P.
City: ~P~~~~L-""-State: C..tl· Ztp: q?~() b
Store No:
Descnolion of work oerformed: I':.ALI&A-r2 -#_l/ qf ; 8'9 A<;; l.tJitrJ'~ ~ /VtV}5~--
~ our Ok' 1/~//l/ t -~-v ,_·~.or. 0'-,"\ II\. I lZ--rr-. ~.urA-l
( I I " .r:",_H:L ... /. •
Du/LtNlr fi?OIV-t 'JhA lA t fr /LI'J-r ~(' A Ml "/" /".AA -_..,_ lJr!J./
~-~Allor ,-::1 f')Q_ I T £.C"Li"' J I~ ~ C<;"LJ\ ;. J /
1~LI~t~A..J LtAJG"... JL...<"7iA...1/-~.AAA -k'~ I &<Jt-fl' ,<s: t'JRJICJ!£}\
~ /1'\...l_<:rLl....' J..c.:\ -;;::. ~l\t; -~~ , ~.r-u;-(
(
I A Sol2... '") J..-.r .S ~f\vct--..rf_. ;:)~ &9 {_
-~__n .:r:IJ ....... A. ]) i&:".LJtr J Sr:::> <-"51'\ 6.4./ I~ ~" -~.~ S/12_.
--J-I h.r CAL.t~.,-:-,.. ,/_ -:J:f-I..J. q[ i~9 ~t~
I~'"' A.JDvJ ltv Obm~')r_p CAu~ LJ.-77(:•rt/.
TRAVEL and LABOR (0.5 tiour Minimum Labor Charge) OVERTIME (5:00 PM ·7:00AM)
Date Technician(s) Name ...... ......... , Start End Total OT Start OTEnd OTTotal
Travel
Labor ':l,. J-.r.<:
Travel
Date Technician(s) Name Start End Total OT Start OTEnd OTTotal
Travel
Labor
Travel
Date Technician(s) Name ' Start End Total OT Start OTEnd OTTotal
Travel
Labor
Travel
SUPPLIES -MATERIALS -RENTALS Check One
Qty. -r.z:i;r:;. • , u!::. I LJ..IT:.<' , """"" ,..-.tA<:"" •.• 10 .-r
'" j ,//
~ AJnTiH£:1\ UST Parts Site Parts
~ f2.1::'7".. ...., .... ' -;-;; • f>&"-7;::.<'1 ;:d. u q, f' ~ q M?.A-J\&: ~
I ,
COMMENTS
~z.__
INVC SITE -\_;ANAR.